197610192-1-29-2024-31-AS-NGID-D2NV57-20240221150725

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610192
Report Date: 01/29/2024
Date Signed: 01/29/2024 03:40:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/22/2024 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20240122163831

FACILITY NAME:	BEST YEARS ASSISTED LIVING, INC		FACILITY NUMBER:	197610192
ADMINISTRATOR:	BALIAN, HOVANNES SHANT		FACILITY TYPE:	740
ADDRESS:	7630 WILBUR AVE.		TELEPHONE:	(818) 732-7737
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 4	DATE:	01/29/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Cheryl Abrigo, Staff		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff not present at facility

INVESTIGATION FINDINGS:

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At 10:00 am, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Staff #1 (S1), who granted access to the facility and explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 10:10 am, LPA requested resident and staff roster. At 10:20 am, LPA requested copies of pertinent information which include, but not limited to staff files, resident files, relevant to the investigation. At approximately 10:50am, LPA conducted a physical plant tour. Between 11:00 am – 1:00 pm, LPA interviewed two (2) staff, a power of attorney for Resident # 1 (R1), registered n urse for R1, and four (4) residents.

LIC 9099-C continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240122163831

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEST YEARS ASSISTED LIVING, INC	FACILITY NUMBER: 197610192
	VISIT DATE: 01/29/2024

NARRATIVE

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Allegation: Staff not present at facility

It was alleged that staff not present at facility. To investigate this allegation LPA conducted interviews with Licensee, two (2) staff, four (4) residents in care, power of attorney for R1, a registered nurse for R1. Interviews and record reviews revealed staff are present at the facility on a set schedule weekly.
interviews with Four (4) out of four (4) Residents was conducted and all four (4) residents denied ever witnessing anyone else except the caregivers at the facility.
Licensee interview was conducted telephonically and LPA was informed that the facility has a set schedule for caregivers. Only a registered nurse is coming once a week for R1 who is hired by the power of attorney for R1. Telephonic interview with power of attorney for R1 revealed that the registered nurse who is scheduled once a week for R1 is hired through Home Health by the power of attorney. Moreover, LPA was informed by the registered nurse that they are only assigned for R1 and is always assisted by a caregiver in the facility at the time of their visit to R1. LPA also observed that the registered nurse providing care to R1 during the time of the visit and was assisted by a caregiver.
LPA conducted interview with the staff and was informed that the staff has a set schedule on a weekly basis and in case of emergency they inform the Licensee and the Licensee provides care in their absence. LPA also reviewed training records for all caregivers and all training records were complete.
Lastly, review of the Facility Personnel Report (LIC 500), conducted by LPA at 10:10 am, did not include anyone else beside the assigned caregivers for residents in care. Based on document reviews, LPA observation and interviews, this allegation is UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC9099 (FAS) - (06/04)

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